Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-25T15:39:19.964Z Has data issue: false hasContentIssue false

Chapter 34 - Management of Severely Brain-Injured Patients Recovering from Coma in the Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

Michel T. Torbey
Affiliation:
Ohio State University
Get access

Summary

Disorders of consciousness, as conceived today, are a relatively recent phenomenon. Indeed, until about 60 years ago, individuals who suffered from a brain injury of the severity that typically leads to a disorder of consciousness rarely survived. In the fifties, the introduction of mechanical ventilation radically changed our ability to extend the life of these patients. This revolutionary advance in critical care, however, confronted clinicians with an almost unprecedented, and highly perplexing, neurological condition in which patients are alive but not responsive to their surroundings. In the past 30 years, and particularly since the introduction of noninvasive brain imaging techniques, patients suffering from this neurological condition have been at the center of flourishing clinical research, aimed at developing a full understanding of loss and recovery of cognitive function after severe brain injury, and scientific interest, aimed at understanding one of the most central aspects of the human brain: consciousness.

Type
Chapter
Information
Neurocritical Care , pp. 404 - 413
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Posner, J, Saper, C, Schiff, N, Plum, F (eds.) (2007). Diagnosis of Stupor and Coma. 4th edn. New York, NY: Oxford University Press.Google Scholar
Jennett, B, Plum, F. (1972). Persistent vegetative state after brain damage: a syndrome in search of a name. Lancet, 1: 734737.CrossRefGoogle ScholarPubMed
The Multi-Society Task Force on PVS. (1994). Medical aspects of the persistent vegetative state (1). N Engl J Med, 330(21): 14991508.CrossRefGoogle Scholar
Landsness, E, Bruno, MA, Noirhomme, Q, et al. (2011). Electrophysiological correlates of behavioural changes in vigilance in vegetative state and minimally conscious state. Brain, 134(8): 22222232.Google Scholar
Laureys, S, Celesia, G, Cohadon, F, et al. (2010). Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med, 8: 68.Google Scholar
Giacino, J, Ashwal, S, Childs, N, et al. (2002). The minimally conscious state: definition and diagnostic criteria. Neurology, 58: 349353.Google Scholar
Bruno, MA, Majerus, S, Boly, M, et al. (2012). Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients. J Neurol, 259(6): 10871098.Google Scholar
Laureys, S, Goldman, S, Phillips, C, et al. (1999). Impaired effective cortical connectivity in vegetative state: preliminary investigation using PET. Neuroimage, 9: 377382.Google Scholar
Vanhaudenhuyse, A, Noirhomme, Q, Tshibanda, LJ, et al. (2010). Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain, 133: 161171.CrossRefGoogle ScholarPubMed
Laureys, S, Faymonville, ME, Degueldre, C, et al. (2000). Auditory processing in the vegetative state. Brain, 123: 15891601.Google Scholar
Laureys, S, Faymonville, ME, Peigneux, P, et al. (2002). Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage, 17: 732741.Google Scholar
Boly, M, Garrido, MI, Gosseries, O, et al. (2011). Preserved feedforward but impaired top-down processes in the vegetative state. Science, 332(6031): 858862.Google Scholar
Laureys, S, Faymonville, ME, Luxen, A, et al. (2000). Restoration of thalamocortical connectivity after recovery from persistent vegetative state. Lancet, 355: 17901791.Google Scholar
Lutkenhoff, ES, McArthur, DL, Hua, X, et al.( 2013). Thalamic atrophy in antero-medial and dorsal nuclei correlates with six-month outcome after severe brain injury. Neuroimage Clin, 3: 396404.Google Scholar
Schiff, ND, Rodriguez-Moreno, D, Kamal, A, et al. (2005). fMRI reveals large-scale network activation in minimally conscious patients. Neurology, 64: 514523.Google Scholar
Bekinschtein, T, Leiguarda, R, Armony, J, et al. (2004). Emotion processing in the minimally conscious state. J Neurol Neurosurg Psychiatry, 75: 788.Google Scholar
Boly, M, Faymonville, ME, Peigneux, P, et al. (2004). auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Arch Neurol, 61: 233238.Google Scholar
Boly, M, Faymonville, ME, Schnakers, C, et al. (2008). Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol, 7: 10131020.Google Scholar
Bekinschtein, T, Tiberti, C, Niklison, J, et al. (2005). Assessing level of consciousness and cognitive changes from vegetative state to full recovery. Neuropsychol Rehabil, 15: 307322.Google Scholar
Fernández-Espejo, D, Bekinschtein, T, Monti, MM, et al. (2011). Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage, 54(1): 103112.Google Scholar
Rosanova, M, Gosseries, O, Casarotto, S, et al. (2012). Recovery of cortical effective connectivity and recovery of consciousness in vegetative patients. Brain, 135(4): 13081320.Google Scholar
Casali, AG, Gosseries, O, Rosanova, M, et al. (2013). A theoretically based index of consciousness independent of sensory processing and behavior. Sci Transl Med, 5(198): 198ra105.CrossRefGoogle ScholarPubMed
Schnakers, C, Vanhaudenhuyse, A, Giacino, J, et al. (2009). Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurol, 9: 35.CrossRefGoogle ScholarPubMed
Andrews, K, Murphy, L, Munday, R, Littlewood, C. (1996). Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ, 313(7048): 1316.Google Scholar
Childs, NL, Mercer, WN, Childs, HW. (1993). Accuracy of diagnosis of persistent vegetative state. Neurology, 43(8): 14651467.Google Scholar
Teasdale, G, Jennett, B. (1976). Assessment and prognosis of coma after head injury. Acta Neurochir (Wien), 34(1–4): 4555.Google Scholar
McNett, M. (2007). A review of the predictive ability of Glasgow Coma Scale scores in head-injured patients. J Neurosci Nurs, 39(2): 6875.Google Scholar
Schnakers, C, Giacino, J, Kalmar, K, et al. (2006). Does the FOUR score correctly diagnose the vegetative and minimally conscious states? Ann Neurol, 60(6): 744745.Google Scholar
Wijdicks, EF, Bamlet, WR, Maramattom, BV, Manno, EM, McClelland, RL. (2005). Validation of a new coma scale: the FOUR score. Ann Neurol, 58(4): 585593.Google Scholar
Giacino, JT, Kalmar, K, Whyte, J. (2004). The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil, 85(12): 20202029.Google Scholar
Seel, RT, Sherer, M, Whyte, J, et al. (2010). Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil, 91(12): 17951813.Google Scholar
Schnakers, C, Chatelle, C, Vanhaudenhuyse, A, et al. (2010). The Nociception Coma Scale: a new tool to assess nociception in disorders of consciousness. Pain, 148(2): 215219.Google Scholar
Chatelle, C, Majerus, S, Whyte, J, Laureys, S, Schnakers, C. (2012). A sensitive scale to assess nociceptive pain in patients with disorders of consciousness. J Neurol Neurosurg Psychiatry, 83(12): 12331237.Google Scholar
Chatelle, C, Thibaut, A, Bruno, MA, et al. (2014). Nociception coma scale-revised scores correlate with metabolism in the anterior cingulate cortex. Neurorehabil Neural Repair, 28(2): 149152.CrossRefGoogle ScholarPubMed
Monti, MM, Laureys, S, Owen, AM. (2010). The vegetative state. BMJ, 341: c3765.Google Scholar
Bruno, MA, Ledoux, D, Vanhaudenhuyse, A, et al. (2012). Prognosis of patients with altered state of consciousness. In Schnakers, C, Laureys, S (eds.), Coma and Disorders of Consciousness. London: Springer-Verlag, 1124.Google Scholar
Royal College of Physicians. (2003). The vegetative state: guidance on diagnosis and management. Clin Med, 3(3): 249254.Google Scholar
Estraneo, A, Moretta, P, Loreto, V, Santoro, L, Trojano, L. (2014). Clinical and neuropsychological long-term outcomes after late recovery of responsiveness: a case series. Arch Phys Med Rehabil, 95(4): 711716.Google Scholar
Giacino, JT, Kezmarsky, MA, DeLuca, J, Cicerone, KD. (1991). Monitoring rate of recovery to predict outcome in minimally responsive patients. Arch Phys Med Rehabil, 72: 897901.Google Scholar
Luauté, J, Maucort-Boulch, D, Tell, L, et al. (2010). Long-term outcomes of chronic minimally conscious and vegetative states. Neurology, 75(3): 246252.Google Scholar
Katz, DI, Polyak, M, Coughlan, D, Nichols, M, Roche, A. (2009). Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up. Prog Brain Res, 177: 7388.Google Scholar
Dolce, G, Lucca, LF, Candelieri, A, et al. (2011). Visual pursuit in the severe disorder of consciousness. J Neurotrauma, 28(7): 11491154.Google Scholar
Whyte, J, Nakase-Richardson, R, Hammond, FM, et al. (2013). Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil, 94(10): 18551860.Google Scholar
Di, H, Schnakers, C. (2012). Sensory stimulation program. In Schnakers, C, Laureys, S (eds.), Coma and Disorders of Consciousness. London: Springer-Verlag, 97104.Google Scholar
Schiff, ND, Giacino, JT, Kalmar, K, et al. (2007). Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature, 448(7153): 600603.Google Scholar
Piccione, F, Cavinato, M, Manganotti, P, et al. (2011). Behavioral and neurophysiological effects of repetitive transcranial magnetic stimulation on the minimally conscious state: a case study. Neurorehabil Neural Repair, 25(1): 98102.CrossRefGoogle ScholarPubMed
Thibaut, A, Bruno, MA, Ledoux, D, Demertzi, A, Laureys, S. (2014). tDCS in patients with disorders of consciousness: Sham-controlled randomized double-blind study. Neurology, 82(13): 11121118.Google Scholar
Giacino, JT, Whyte, J, Bagiella, E, et al. (2012). Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med, 366(9): 819826.Google Scholar
Thonnard, M, Gosseries, O, Demertzi, A, et al. (2013). Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study. Funct Neurol, 28(4): 259264.Google ScholarPubMed
Whyte, J, Rajan, R, Rosenbaum, A, et al. (2014). Zolpidem and restoration of consciousness. Am J Phys Med Rehabil, 93(2): 101113.Google Scholar
Owen, AM, Coleman, MR, Boly, M, et al. (2006). Detecting awareness in the vegetative state. Science, 313(5792): 1402.CrossRefGoogle ScholarPubMed
Monti, MM, Vanhaudenhuyse, A, Coleman, MR, et al. (2010). Willful modulation of brain activity in disorders of consciousness. N Engl J Med, 362(7): 579589.CrossRefGoogle ScholarPubMed
Monti, MM. (2012). Cognition in the vegetative state. Annu Rev Clin Psychol, 8: 431454.Google Scholar
Laureys, S, Pellas, F, Van Eeckhout, P, et al. (2005). The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless? Prog Brain Res, 150: 495511.Google Scholar
Schiff, ND. (2010). Recovery of consciousness after brain injury: a mesocircuit hypothesis. Trends Neurosci, 33(1): 19.Google Scholar
Cruse, D, Chennu, S, Chatelle, C, et al. (2012). Relationship between etiology and covert cognition in the minimally conscious state. Neurology, 78(11): 816822.Google Scholar
Cruse, D, Chennu, S, Chatelle, C, et al. (2011). Bedside detection of awareness in the vegetative state: a cohort study. Lancet, 378(9809): 20882094.Google Scholar
Naci, L, Monti, MM, Cruse, D, et al. (2012). Brain-computer interfaces for communication with nonresponsive patients. Ann Neurol, 72(3): 312323.Google Scholar
Donchin, E, Spencer, KM, Wijesinghe, R. (2000). The mental prosthesis: assessing the speed of a P300-based brain-computer interface. IEEE Trans Rehabil Eng, 8(2): 174179.Google Scholar
Lulé, D, Noirhomme, Q, Kleih, SC, et al. (2013). Probing command following in patients with disorders of consciousness using a brain-computer interface. Clin Neurophysiol, 124(1): 101106.Google Scholar
Naci, L, Owen, AM. (2013). Making every word count for nonresponsive patients. JAMA Neurol, 70(10): 12351241.Google Scholar
Kübler, A, Furdea, A, Halder, S, et al. (2009). A brain-computer interface controlled auditory event-related potential (p300) spelling system for locked-inpatients. Ann N Y Acad Sci, 1157: 90100.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×